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. 2024 Oct;76(5):4499-4505.
doi: 10.1007/s12070-024-04897-0. Epub 2024 Jul 18.

Endoscopic Double Flap Tympanoplasty

Shafaat Ahmad  1 , Ravi Meher  1 , Praveen Kumar Rathore  1 , Ishwar Singh  1 , Vikram Wadhwa  1 , Prakhar Goel  1 , Swezal Lohia  1 , Ananthula Sahaja  1
Affiliations

Endoscopic Double Flap Tympanoplasty

Shafaat Ahmad et al. Indian J Otolaryngol Head Neck Surg. 2024 Oct.

Abstract

Aim: This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant.

Methodology: In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared.

Results: Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant.

Conclusions: In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial.

Keywords: Conductive Hearing loss; Endoscopy; Methods; Tympanic Membrane Perforation; Tympanoplasty.

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Figures

Fig. 1
Fig. 1
Steps of EDFT: (a) Pinna stay suture, (b) Large central perforation, (c) Freshening the margin, (d) Elevating posterior TMF, (e) Incision for anterior TMF, (f) Elevating anterior TMF, (g) Trimming the temporalis fascia graft, (h) Graft placed in the middle ear visible through anterior tunnel, (i) Pulling anterior tab of graft underneath anterior tunnel, (j) Anterior and posterior TMFs repositioned, (k) Gelfoam placed in the middle ear after raising graft-flap assembly, (l) Final position of graft
Fig. 2
Fig. 2
Postoperative results at 3 months follow up visit
See this image and copyright information in PMC

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